CA2207242A1 - Thoracoscopic transmyocardial revascularization handpiece assembly - Google Patents
Thoracoscopic transmyocardial revascularization handpiece assemblyInfo
- Publication number
- CA2207242A1 CA2207242A1 CA002207242A CA2207242A CA2207242A1 CA 2207242 A1 CA2207242 A1 CA 2207242A1 CA 002207242 A CA002207242 A CA 002207242A CA 2207242 A CA2207242 A CA 2207242A CA 2207242 A1 CA2207242 A1 CA 2207242A1
- Authority
- CA
- Canada
- Prior art keywords
- handpiece
- barrel
- transmyocardial revascularization
- contacting surface
- laser beam
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Abandoned
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
- A61B18/201—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser with beam delivery through a hollow tube, e.g. forming an articulated arm ; Hand-pieces therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00243—Type of minimally invasive operation cardiac
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00243—Type of minimally invasive operation cardiac
- A61B2017/00247—Making holes in the wall of the heart, e.g. laser Myocardial revascularization
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00345—Vascular system
- A61B2018/00351—Heart
- A61B2018/00392—Transmyocardial revascularisation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/03—Automatic limiting or abutting means, e.g. for safety
- A61B2090/033—Abutting means, stops, e.g. abutting on tissue or skin
- A61B2090/036—Abutting means, stops, e.g. abutting on tissue or skin abutting on tissue or skin
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2218/00—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2218/001—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body having means for irrigation and/or aspiration of substances to and/or from the surgical site
- A61B2218/002—Irrigation
- A61B2218/006—Irrigation for smoke evacuation
Abstract
A thoracoscopic transmyocardial revascularization handpiece assembly (20) for a medical laser system (12) includes an elongate barrel (22) having a narrow width sized to fit between the ribs of a patient and having a first passage therethrough; an elongate handpiece (24) extending from the barrel (22) and having a similarly narrow width commensurate with the barrel (22) and having a second passage therethrough; and a contacting surface (32) on the distal end of the handpiece (24) for contacting the wall of the patient's heart; the contacting surface (32) having a width in a first dimension which is approximately that of the handpiece (24) and having a width in a second dimension which is larger than the cross-sectional area of the handpiece (24); an aperture in the contacting surface (32) communicating with the second passage for transmitting the laser beam (31); and focusing means (30) in the barrel (22) for focusing the laser beam (31) proximate to the aperture.
Description
CA 02207242 l997-06-06 W O 97/13468 PCTrUS96/15116 T H OE~C OSC OPIC T~A~S M YO CA~R~DIA~L ~UEVASC mLAiRIZATIO N
HANDPIECE ASSEMBLY
FIELD OF INVENTION
This invention relates to a handpiece for a mPclic~l laser system such as a 5 transmyocardial revascularization laser system, and more particularly to such a handpiece which is narrow enough to be slid between the ribs of the patient.
RELATED CASES
This application is a co~ ion-in-part of Serial Number 08/190,950 filed February 3, 1994, which is a continll~tion-in-part of serial number 08/201,052 filed February 24, 1994, which is a continu~tion of serial number 08/014,363 filed February 5, 1993, which is a contiml~tion of serial number 07/928,531 ~lled August 13, 1992, which is a contim~tion of serial number 07/586,891 filed September 24, 1990. This application incorporates herein by reference the following patents having common inventors and assignee: application serial number 586,885 filed September 24, 1990, issued as United States Patent 5,109,388, and application serial number 586,951 filed September 24, 1990, issued as United States Patent 5,125,926.
BACKGROUND OF INVENTION
Transmyocardial revascularization (TMR) is an alternative technique to bypass surgery for increasing blood flow to the heart muscle. TMR involves puncturing the 20 heart wall with a laser to form a plurality of holes which heal on the outside but remain open on the inside of the heart to provide an ~ltern~tive source of blood to the heart muscle. This technique has been used on a beating heart without the need to slow or still it. This has been accomplished with an innovative synchronizing approach disclosed in U.S. Patents 5,125,926 and 5,109,388, incorporated herein by lerelellce. The procedure 25 is performed using a handpiece having a broad cont~rting wall and a knurled surface on the face of the cont~cting wall which allows the surgeon to properly align the handpiece on t~e heart wall and to avoid slipping of the handpiece during the procedures. However, as with any open heart surgical procedure, the rib cage of the patient must be opened up CA 02207242 l997-06-06 W O 97/13468 PCT~US96/15116 in order to provide access to the heart. This procedure is extremely invasive, can cause broken ribs, lengthy recovery periods and increased risk of infection, not only from the transmyocardial revascularization itself, but also from the opening of the chest cavity.
While in some cases this type of invasive surgery may be unavoidable, in the case of an elderly patient, a less invasive procedure would cut down on the problems associated with this type of surgery.
SUMMARY OF INVENTION
It is therefore an object of this invention to provide an improved laser handpiece assembly for a laser system for transmyocardial revascularization.
It is a further object of this invention to provide such a laser handpiece assembly which elimin~tes the need to open the chest cavity to perform transmyocardial revascularization .
It is a further object of this invention to provide such a laser handpiece assembly which more readily m~int~in~ perpen~lic~ rity with the wall of a beating heart.
It is a further object of this invention to provide such a laser handpiece assembly which accurately locates the laser beam focal point at the correct point on the heart wall.
It is a further object of this invention to provide such a laser handpiece assembly which dissipates the laser plume to prevent interference with or damage to the laser beam lens.
It is a further object of this invention to provide such a laser handpiece assembly which prevents movement of the handpiece with respect to the heart wall.
The invention results from the realization that a truly effective thoracoscopic handpiece assembly for minim~lly invasive transmyocardial revascularization which reduces pain, bleeding, and the possibility of broken ribs or postoperative infection can be achieved with a narrow elongate handpiece which is slim enough to be slid between adjacent ribs for ~lmini~tering a laser beam to the heart wall and which is long enough to enable physician manipulation from outside the rib cage.
This invention features a thoracoscopic transmyocardial revascularization handpiece assembly for a medical laser system. There is an elongate barrel having a narrow width sized to fit between the ribs of a patient and having a first passage W O 97/13468 PCT~US96/15116 therethrough for con~ ctin~ a surgical laser beam. There is an elongate handpiece exten~ling from the barrel and having a similarly narrow width con me~iu~t~ with the barrel and having a second passage theLet~llvugh conn~cting with the first passage for con~ cting a surgical laser beam. A cont~cting surface on the distal end of the handpiece 5 cont~et~ the wall of the patient's heart. The cont~r,ting surface has a width in a ~lrst ~limen~ion which is approximately that of the handpiece for ~ltting between the ribs of a patient and having a width in a second dimen~i-)n which is larger to effect an area of the cont~eting surface which is substantially larger than the cross-sectional area of the handpiece. There is an aperture in the cont~r-ting surface co~ lir~tinp with the second 10 passage for trm~mittin~ the laser beam, and there are focusing means in the barrel for focusing the laser beam proximate to the aperture to ablate the tissue of the heart wall and create a hole to the interior heart chamber.
In a preferred embodiment the barrel and the handpiece may be separate and theremay be further inrhl-led means for coupling the proximal end of the handpiece to the 15 distal end of the barrel. The barrel and the handpiece may also be integral. The cont~cting surface may be knurled for preventing movement of the cont~cting wall with respect to the heart wall during surgery. The cont~rting surface may be at an angle to the longihlrlin~l axis of the handpiece. For example, the cont~cting surface may be perpendicular to the longihl~lin~l axis of the handpiece. The handpiece may further 20 include a cutout portion proximate the cont~cting surface. The barrel may include means for introducing a purge gas into the handpiece to create a back pres~u,e to force the ablated tissue out of the cutout portion and to keep the ablated tissue away from the focusing means. The cont~cting surface may be parallel to the lon~hll(lin~l axis of the handpiece. The handpiece may further include deflecting means for directing the laser 25 beam to the aperture. The handpiece may further include at least one port for exh~llsting the ablated tissue. The barrel may include means for introducing a purge gas into the handpiece to create backpressure to force the ablated tissue out of the at least one port and to keep the ablated tissue away from the focusing means The means for coupling may include a friction fit between the proximal end of the handpiece and the distal end of 30 the barrel. The barrel may further include means including an in~ ting portion for coupling the proximal end of the barrel to the laser system.
-CA 02207242 l997-06-06 W O 97/13468 PCT~US96/15116 The invention also features a thoracoscopic transmyocardial revascularization handpiece assembly for a m-o-lir~l laser system which inrhldes an elongate barrel having a narrow width to fit between the ribs of a patient and having a first passage therethrough for conrlnctin~: a surgical laser beam. There is an elongate handpiece having a similarly narrow width commel~ulat~ with the barrel and having a second passage therethrough conn~cting with the first passage for con~lllcting a surgical laser beam. There are means for coupling the proximal end of the handpiece to the distal end of the barrel. The cont~ting surface of the distal end of the handpiece contacts the wall of the patient's heart. The cont~ting surface has a width in the first dimension which is approximately that of the handpiece for fitting between the ribs of a patient, and having a width in a second ~lim~n~ion which is larger to effect an area of the cont~ting surface which is substantially larger than the cross-sectional area of the handpiece. There is an a~ellule in the cont~cting surface communicating with the second passage for tr~n~mitting the laser beam and there are focusing means in the barrel for focusing the laser beam proximate to the aperture to ablate the tissue of the heart wall and create a hole in the interior of the heart chamber.
DISCLOSURE OF PREFERRED EMBODIMENT
Other objects, features and advantages will occur to those skilled in the art from the following description of a plerelled embodiment and the accompanying drawings, in which:
Fig. 1 is a three-dimensional view of a laser system which utilizes the handpiece assembly of this invention;
Fig. 2 is an enlarged, more detailed, exploded three-dimensional view of a portion of the artirul~te~ arm in Fig. 1 and a first embodiment of the invention;
Fig. 3 is an enlarged, more detailed, exploded three-dimensional view of a portion of the articulated arm in Fig. 1 and a second embodiment of the invention; and Fig. 4 is an enlarged, more detailed exploded three-dimensional view of a portion of the articulated arm in Fig. 1 and another embodiment of the invention in which the band and handpiece are integral.
There is shown in Fig. 1 a surgical laser system 10 which includes a power supply CA 02207242 l997-06-06 W O 97/13468 PCT~US96/15116 and control 12 operated through control and monitor screen 14 to operate laser 16. The output from laser 16 is directed through articul~tP~l arm 18 to handpiece assembly 20 typically held by the operator or surgeon to direct the beam at the desired target.
~, Handpiece assembly 20, Fig. 2, includes barrel 22 and handpiece 24. Barrel 22 inrln-les threaded portion 26 for conn~octi- n to articulated arm 18 at threaded portion 27, and purge tube 28 for introducing a purge gas into handpiece 24. Handpiece 24 inchl(les cont~tinp wall 32 having a knurled surface 33 for preventing slippage of handpiece 24 on the heart during surgery. There is an aperture 34 in cont~rting wall 32 through which laser beam 31 exits to strike the heart. Lens 30, shown in ph~ntom in barrel 22, focuses laser bearn 31 at a pre~letPrmined tli~t~n~e, typically at or near aperture 34. Handpiece 24 also includes cutout portion 36 through which the user can view the beam as it enters aperture 34. Cutout portion 36 also acts as a venting hole for the ablative plume which rises from the heart or other tissue struck by the laser beam 31. Handpiece 24 includes coupling portion 38a which slides over coupling portion 38b of barrel 22 in order to effect a friction fit. There is a slot 40 in coupling portion 38a which accepts the distal end of purge tube 28.
In accordance with this invention, barrel 22 and handpiece 24 typically have diameters in the range of 3/8 inch to 5/8 inch. This allows the handpiece assembly to be slid between adjacent ribs of a patient in order to access the heart without opening the chest cavity. Generally, the space between ribs of a patient is approximately 0.5". As can be seen in the figure, conf~rting wall 32 of handpiece 24 is formed such that the width of the cont~ting wall is the same as the rli~meter of handpiece 24 while the length of cont~cting wall 32 is approxirnately twice the diameter of handpiece 24. This increases the area of contact with the heart and therefore decreases the l)rcs,ule of force per unit area on the heart. It also provides a more stable platform by which to m~int~in perpendicularity between the beam 31 and the heart wall and reduces the chances of the ~ handpiece puncturing or otherwise ~l~m~ging the heart tissue. However, the narrow width of cont~rting wall 32 allows handpiece assembly 20 to be slid between adjacent ribs of the patient.
Purge tube 28 is connected to a purge gas source which provides a gas such as carbon dioxide under a gentle flow, typically one to three liters per minute, to create a CA 02207242 l997-06-06 W O 97/13468 PCTrUS96/15116 back ~res~u-e from lens 30 forward into handpiece 24. This keeps any debris from the ablation from cont~cting and obscuring or ~i~m~ging lens 30.
Although handpiece assembly 20 has been shown with handpiece 24 as a straight member, this is not a n~ce~s~ry limit~ti~ln of the invention: handpiece 24 may be S constructed at any desired angle. For example, handpiece 24a, Fig. 3, may include a right angle configuration so that cont~rting wall 32a and aperture 34a are facing at a right angle to the path of laser beam 31. A reflective surface 42 is provided to reflect the beam from an incoming path parallel to axis 44 to the outgoing path parallel to axis 46.
One or more vent holes 48 may be provided for e~h~n~tinp; gas and ablated tissue aided by the back pressure caused by the introduction of the purge gas through purge tube 28.
In this embotliment, reflective surface 42 is enclosed as much as possible in order to minimi7~ co~ tion from body fluids prior to firing the laser.
In the ~l~r~lr~d embodiment, barrel 22 is formed of stainless steel due to its strength, its ability to be sterili_ed repeatedly and its ability to with~t~n~l heat from the unfocused laser before it is focused by lens 30. Purge tube 28 is also formed of stainless steel and is typically welded to barrel 22. Handpiece 24 is typically injection molded of medical grade clear acrylic. This allows the surgeon to monitor the laser beam as it passes through the handpiece, allows more effective cleaning of the inside of the handpiece during surgery and enh~n~ç~ the disposability of the handpiece. Coupling portion 38a of handpiece 24, however, is formed of the same stainless steel as barrel 22.
This allows for a tighter friction fit between handpiece 24 and barrel 22 which is not affected by changes in lelllpelaLule due to the heat of the laser. Threaded portion 26 of barrel 22 is typically formed of an electrical insulating material such as Delrin to electrically insulate the patient from the laser system, and to avoid additional grounding locations for electrocautery devices used on the patient. Also, lens 30 has a five-inch focal length which focuses beam 31 at aperture 34 in the case of the embodiment of Fig.
HANDPIECE ASSEMBLY
FIELD OF INVENTION
This invention relates to a handpiece for a mPclic~l laser system such as a 5 transmyocardial revascularization laser system, and more particularly to such a handpiece which is narrow enough to be slid between the ribs of the patient.
RELATED CASES
This application is a co~ ion-in-part of Serial Number 08/190,950 filed February 3, 1994, which is a continll~tion-in-part of serial number 08/201,052 filed February 24, 1994, which is a continu~tion of serial number 08/014,363 filed February 5, 1993, which is a contiml~tion of serial number 07/928,531 ~lled August 13, 1992, which is a contim~tion of serial number 07/586,891 filed September 24, 1990. This application incorporates herein by reference the following patents having common inventors and assignee: application serial number 586,885 filed September 24, 1990, issued as United States Patent 5,109,388, and application serial number 586,951 filed September 24, 1990, issued as United States Patent 5,125,926.
BACKGROUND OF INVENTION
Transmyocardial revascularization (TMR) is an alternative technique to bypass surgery for increasing blood flow to the heart muscle. TMR involves puncturing the 20 heart wall with a laser to form a plurality of holes which heal on the outside but remain open on the inside of the heart to provide an ~ltern~tive source of blood to the heart muscle. This technique has been used on a beating heart without the need to slow or still it. This has been accomplished with an innovative synchronizing approach disclosed in U.S. Patents 5,125,926 and 5,109,388, incorporated herein by lerelellce. The procedure 25 is performed using a handpiece having a broad cont~rting wall and a knurled surface on the face of the cont~cting wall which allows the surgeon to properly align the handpiece on t~e heart wall and to avoid slipping of the handpiece during the procedures. However, as with any open heart surgical procedure, the rib cage of the patient must be opened up CA 02207242 l997-06-06 W O 97/13468 PCT~US96/15116 in order to provide access to the heart. This procedure is extremely invasive, can cause broken ribs, lengthy recovery periods and increased risk of infection, not only from the transmyocardial revascularization itself, but also from the opening of the chest cavity.
While in some cases this type of invasive surgery may be unavoidable, in the case of an elderly patient, a less invasive procedure would cut down on the problems associated with this type of surgery.
SUMMARY OF INVENTION
It is therefore an object of this invention to provide an improved laser handpiece assembly for a laser system for transmyocardial revascularization.
It is a further object of this invention to provide such a laser handpiece assembly which elimin~tes the need to open the chest cavity to perform transmyocardial revascularization .
It is a further object of this invention to provide such a laser handpiece assembly which more readily m~int~in~ perpen~lic~ rity with the wall of a beating heart.
It is a further object of this invention to provide such a laser handpiece assembly which accurately locates the laser beam focal point at the correct point on the heart wall.
It is a further object of this invention to provide such a laser handpiece assembly which dissipates the laser plume to prevent interference with or damage to the laser beam lens.
It is a further object of this invention to provide such a laser handpiece assembly which prevents movement of the handpiece with respect to the heart wall.
The invention results from the realization that a truly effective thoracoscopic handpiece assembly for minim~lly invasive transmyocardial revascularization which reduces pain, bleeding, and the possibility of broken ribs or postoperative infection can be achieved with a narrow elongate handpiece which is slim enough to be slid between adjacent ribs for ~lmini~tering a laser beam to the heart wall and which is long enough to enable physician manipulation from outside the rib cage.
This invention features a thoracoscopic transmyocardial revascularization handpiece assembly for a medical laser system. There is an elongate barrel having a narrow width sized to fit between the ribs of a patient and having a first passage W O 97/13468 PCT~US96/15116 therethrough for con~ ctin~ a surgical laser beam. There is an elongate handpiece exten~ling from the barrel and having a similarly narrow width con me~iu~t~ with the barrel and having a second passage theLet~llvugh conn~cting with the first passage for con~ cting a surgical laser beam. A cont~cting surface on the distal end of the handpiece 5 cont~et~ the wall of the patient's heart. The cont~r,ting surface has a width in a ~lrst ~limen~ion which is approximately that of the handpiece for ~ltting between the ribs of a patient and having a width in a second dimen~i-)n which is larger to effect an area of the cont~eting surface which is substantially larger than the cross-sectional area of the handpiece. There is an aperture in the cont~r-ting surface co~ lir~tinp with the second 10 passage for trm~mittin~ the laser beam, and there are focusing means in the barrel for focusing the laser beam proximate to the aperture to ablate the tissue of the heart wall and create a hole to the interior heart chamber.
In a preferred embodiment the barrel and the handpiece may be separate and theremay be further inrhl-led means for coupling the proximal end of the handpiece to the 15 distal end of the barrel. The barrel and the handpiece may also be integral. The cont~cting surface may be knurled for preventing movement of the cont~cting wall with respect to the heart wall during surgery. The cont~rting surface may be at an angle to the longihlrlin~l axis of the handpiece. For example, the cont~cting surface may be perpendicular to the longihl~lin~l axis of the handpiece. The handpiece may further 20 include a cutout portion proximate the cont~cting surface. The barrel may include means for introducing a purge gas into the handpiece to create a back pres~u,e to force the ablated tissue out of the cutout portion and to keep the ablated tissue away from the focusing means. The cont~cting surface may be parallel to the lon~hll(lin~l axis of the handpiece. The handpiece may further include deflecting means for directing the laser 25 beam to the aperture. The handpiece may further include at least one port for exh~llsting the ablated tissue. The barrel may include means for introducing a purge gas into the handpiece to create backpressure to force the ablated tissue out of the at least one port and to keep the ablated tissue away from the focusing means The means for coupling may include a friction fit between the proximal end of the handpiece and the distal end of 30 the barrel. The barrel may further include means including an in~ ting portion for coupling the proximal end of the barrel to the laser system.
-CA 02207242 l997-06-06 W O 97/13468 PCT~US96/15116 The invention also features a thoracoscopic transmyocardial revascularization handpiece assembly for a m-o-lir~l laser system which inrhldes an elongate barrel having a narrow width to fit between the ribs of a patient and having a first passage therethrough for conrlnctin~: a surgical laser beam. There is an elongate handpiece having a similarly narrow width commel~ulat~ with the barrel and having a second passage therethrough conn~cting with the first passage for con~lllcting a surgical laser beam. There are means for coupling the proximal end of the handpiece to the distal end of the barrel. The cont~ting surface of the distal end of the handpiece contacts the wall of the patient's heart. The cont~ting surface has a width in the first dimension which is approximately that of the handpiece for fitting between the ribs of a patient, and having a width in a second ~lim~n~ion which is larger to effect an area of the cont~ting surface which is substantially larger than the cross-sectional area of the handpiece. There is an a~ellule in the cont~cting surface communicating with the second passage for tr~n~mitting the laser beam and there are focusing means in the barrel for focusing the laser beam proximate to the aperture to ablate the tissue of the heart wall and create a hole in the interior of the heart chamber.
DISCLOSURE OF PREFERRED EMBODIMENT
Other objects, features and advantages will occur to those skilled in the art from the following description of a plerelled embodiment and the accompanying drawings, in which:
Fig. 1 is a three-dimensional view of a laser system which utilizes the handpiece assembly of this invention;
Fig. 2 is an enlarged, more detailed, exploded three-dimensional view of a portion of the artirul~te~ arm in Fig. 1 and a first embodiment of the invention;
Fig. 3 is an enlarged, more detailed, exploded three-dimensional view of a portion of the articulated arm in Fig. 1 and a second embodiment of the invention; and Fig. 4 is an enlarged, more detailed exploded three-dimensional view of a portion of the articulated arm in Fig. 1 and another embodiment of the invention in which the band and handpiece are integral.
There is shown in Fig. 1 a surgical laser system 10 which includes a power supply CA 02207242 l997-06-06 W O 97/13468 PCT~US96/15116 and control 12 operated through control and monitor screen 14 to operate laser 16. The output from laser 16 is directed through articul~tP~l arm 18 to handpiece assembly 20 typically held by the operator or surgeon to direct the beam at the desired target.
~, Handpiece assembly 20, Fig. 2, includes barrel 22 and handpiece 24. Barrel 22 inrln-les threaded portion 26 for conn~octi- n to articulated arm 18 at threaded portion 27, and purge tube 28 for introducing a purge gas into handpiece 24. Handpiece 24 inchl(les cont~tinp wall 32 having a knurled surface 33 for preventing slippage of handpiece 24 on the heart during surgery. There is an aperture 34 in cont~rting wall 32 through which laser beam 31 exits to strike the heart. Lens 30, shown in ph~ntom in barrel 22, focuses laser bearn 31 at a pre~letPrmined tli~t~n~e, typically at or near aperture 34. Handpiece 24 also includes cutout portion 36 through which the user can view the beam as it enters aperture 34. Cutout portion 36 also acts as a venting hole for the ablative plume which rises from the heart or other tissue struck by the laser beam 31. Handpiece 24 includes coupling portion 38a which slides over coupling portion 38b of barrel 22 in order to effect a friction fit. There is a slot 40 in coupling portion 38a which accepts the distal end of purge tube 28.
In accordance with this invention, barrel 22 and handpiece 24 typically have diameters in the range of 3/8 inch to 5/8 inch. This allows the handpiece assembly to be slid between adjacent ribs of a patient in order to access the heart without opening the chest cavity. Generally, the space between ribs of a patient is approximately 0.5". As can be seen in the figure, conf~rting wall 32 of handpiece 24 is formed such that the width of the cont~ting wall is the same as the rli~meter of handpiece 24 while the length of cont~cting wall 32 is approxirnately twice the diameter of handpiece 24. This increases the area of contact with the heart and therefore decreases the l)rcs,ule of force per unit area on the heart. It also provides a more stable platform by which to m~int~in perpendicularity between the beam 31 and the heart wall and reduces the chances of the ~ handpiece puncturing or otherwise ~l~m~ging the heart tissue. However, the narrow width of cont~rting wall 32 allows handpiece assembly 20 to be slid between adjacent ribs of the patient.
Purge tube 28 is connected to a purge gas source which provides a gas such as carbon dioxide under a gentle flow, typically one to three liters per minute, to create a CA 02207242 l997-06-06 W O 97/13468 PCTrUS96/15116 back ~res~u-e from lens 30 forward into handpiece 24. This keeps any debris from the ablation from cont~cting and obscuring or ~i~m~ging lens 30.
Although handpiece assembly 20 has been shown with handpiece 24 as a straight member, this is not a n~ce~s~ry limit~ti~ln of the invention: handpiece 24 may be S constructed at any desired angle. For example, handpiece 24a, Fig. 3, may include a right angle configuration so that cont~rting wall 32a and aperture 34a are facing at a right angle to the path of laser beam 31. A reflective surface 42 is provided to reflect the beam from an incoming path parallel to axis 44 to the outgoing path parallel to axis 46.
One or more vent holes 48 may be provided for e~h~n~tinp; gas and ablated tissue aided by the back pressure caused by the introduction of the purge gas through purge tube 28.
In this embotliment, reflective surface 42 is enclosed as much as possible in order to minimi7~ co~ tion from body fluids prior to firing the laser.
In the ~l~r~lr~d embodiment, barrel 22 is formed of stainless steel due to its strength, its ability to be sterili_ed repeatedly and its ability to with~t~n~l heat from the unfocused laser before it is focused by lens 30. Purge tube 28 is also formed of stainless steel and is typically welded to barrel 22. Handpiece 24 is typically injection molded of medical grade clear acrylic. This allows the surgeon to monitor the laser beam as it passes through the handpiece, allows more effective cleaning of the inside of the handpiece during surgery and enh~n~ç~ the disposability of the handpiece. Coupling portion 38a of handpiece 24, however, is formed of the same stainless steel as barrel 22.
This allows for a tighter friction fit between handpiece 24 and barrel 22 which is not affected by changes in lelllpelaLule due to the heat of the laser. Threaded portion 26 of barrel 22 is typically formed of an electrical insulating material such as Delrin to electrically insulate the patient from the laser system, and to avoid additional grounding locations for electrocautery devices used on the patient. Also, lens 30 has a five-inch focal length which focuses beam 31 at aperture 34 in the case of the embodiment of Fig.
2 and at aperture 34a in the case of the embodiment of Fig. 3.
While handpiece assembly 20, Figs. 2 and 3, has been shown as including two separate sections, barrel 22 and handpiece 24 (24a), that is not a necess~ry limit~tinn of the invention. Handpiece assembly 20b, Fig. 4, may be made as a single integral unit including both barrel 22b and handpiece 24b.
CA 02207242 l997-06-06 W O 97/13468 PCTrUS96/15116 Although specific Çealuies of this invention are shown in some drawings and not others, this is for convenience only as each feature may be combined with any or all of the other Çealu,~s in accordance with the invention.
Other embo~liment~ will occur to those skilled in the art and are within the S following claims:
What is ~l~imPrl is:
While handpiece assembly 20, Figs. 2 and 3, has been shown as including two separate sections, barrel 22 and handpiece 24 (24a), that is not a necess~ry limit~tinn of the invention. Handpiece assembly 20b, Fig. 4, may be made as a single integral unit including both barrel 22b and handpiece 24b.
CA 02207242 l997-06-06 W O 97/13468 PCTrUS96/15116 Although specific Çealuies of this invention are shown in some drawings and not others, this is for convenience only as each feature may be combined with any or all of the other Çealu,~s in accordance with the invention.
Other embo~liment~ will occur to those skilled in the art and are within the S following claims:
What is ~l~imPrl is:
Claims (15)
1. A thoracoscopic transmyocardial revascularization handpiece assembly for a medical laser system, comprising:
an elongate barrel having a narrow width sized to fit between the ribs of a patient and having a first passage therethrough for conducting a surgical laser beam;
an elongate handpiece extending from said barrel and having a similarly narrow width commensurate with said barrel and having a second passage therethrough connecting with said first passage for conducting a surgical laser beam;
a contacting surface on the distal end of said handpiece for contacting the wall of the patient's heart; said contacting surface having a width in a first dimension which is approximately that of said handpiece for fitting between the ribs of a patient and having a width in a second dimension which is larger to effect an area of said contacting surface which is substantially larger than the cross-sectional area of said handpiece;
an aperture in said contacting surface communicating with said second passage for transmitting the laser beam; and focusing means in said barrel for focusing the laser beam proximate to the aperture to ablate the tissue of the heart wall and create a hole to the interior heart chamber.
an elongate barrel having a narrow width sized to fit between the ribs of a patient and having a first passage therethrough for conducting a surgical laser beam;
an elongate handpiece extending from said barrel and having a similarly narrow width commensurate with said barrel and having a second passage therethrough connecting with said first passage for conducting a surgical laser beam;
a contacting surface on the distal end of said handpiece for contacting the wall of the patient's heart; said contacting surface having a width in a first dimension which is approximately that of said handpiece for fitting between the ribs of a patient and having a width in a second dimension which is larger to effect an area of said contacting surface which is substantially larger than the cross-sectional area of said handpiece;
an aperture in said contacting surface communicating with said second passage for transmitting the laser beam; and focusing means in said barrel for focusing the laser beam proximate to the aperture to ablate the tissue of the heart wall and create a hole to the interior heart chamber.
2. The thoracoscopic transmyocardial revascularization handpiece assembly of claim 1 in which said barrel and said handpiece are separate and there is further included means for coupling the proximal end of said handpiece to the distal end of said barrel.
3. The thoracoscopic transmyocardial revascularization handpiece assembly of claim 1 in which said barrel and said handpiece are integral.
4. The thoracoscopic transmyocardial revascularization handpiece assembly of claim 1 in which said contacting surface is knurled for preventing movement of said contacting wall with respect to the heart wall during surgery.
5. The thoracoscopic transmyocardial revascularization handpiece assembly of claim 1 in which said contacting surface is at an angle to the longitudinal axis of said handpiece.
6. The thoracoscopic transmyocardial revascularization handpiece assembly of claim 4 in which said contacting surface is perpendicular to the longitudinal axis of said handpiece.
7. The thoracoscopic transmyocardial revascularization handpiece assembly of claim 6 in which said handpiece further includes a cutout portion proximate said contacting surface.
8. The thoracoscopic transmyocardial revascularization handpiece assembly of claim 7 in which said barrel includes means for introducing a purge gas into said handpiece to create a back pressure to force said ablated tissue out of said cutout portion and to keep said ablated tissue away from said focusing means.
9. The thoracoscopic transmyocardial revascularization handpiece assembly of claim 4 in which said contacting surface is parallel to the longitudinal axis of said handpiece.
10. The thoracoscopic transmyocardial revascularization handpiece assembly of claim 9 in which said handpiece further includes deflecting means for directing said laser beam to said aperture.
11. The thoracoscopic transmyocardial revascularization handpiece assembly of claim 10 in which said handpiece further includes at least one port for exhausting said ablated tissue.
12. The thoracoscopic transmyocardial revascularization handpiece assembly of claim 11 in which said barrel includes means for introducing a purge gas into said handpiece to create a back pressure to force said ablated tissue out of said at least one port and to keep said ablated tissue away from said focusing means.
13. The thoracoscopic transmyocardial revascularization handpiece assembly of claim 2 in which said means for coupling includes a friction fit between said proximal end of said handpiece and said distal end of said barrel.
14. The thoracoscopic transmyocardial revascularization handpiece assembly of claim 2 in which said barrel further includes means, including an insulating portion, for coupling the proximal end of said barrel to said laser system.
15. A thoracoscopic transmyocardial revascularization handpiece assembly for a medical laser system, comprising:
an elongate barrel having a narrow width sized to fit between the ribs of a patient and having a first passage therethrough for conducting a surgical laser beam;
an elongate handpiece having a similarly narrow width commensurate with said barrel and having a second passage therethrough connecting with said first passage for conducting a surgical laser beam;
means for coupling the proximal end of said handpiece to the distal end of said barrel;
a contacting surface on the distal end of said handpiece for contacting the wall of the patient's heart; said contacting surface having a width in a first dimension which is approximately that of said handpiece for fitting between the ribs of a patient and having a width in a second dimension which is larger to effect an area of said contacting surface which is substantially larger than the cross-sectional area of said handpiece;
an aperture in said contacting surface communicating with said second passage for transmitting the laser beam; and focusing means in said barrel for focusing the laser beam proximate to the aperture to ablate the tissue of the heart wall and create a hole to the interior heart chamber.
an elongate barrel having a narrow width sized to fit between the ribs of a patient and having a first passage therethrough for conducting a surgical laser beam;
an elongate handpiece having a similarly narrow width commensurate with said barrel and having a second passage therethrough connecting with said first passage for conducting a surgical laser beam;
means for coupling the proximal end of said handpiece to the distal end of said barrel;
a contacting surface on the distal end of said handpiece for contacting the wall of the patient's heart; said contacting surface having a width in a first dimension which is approximately that of said handpiece for fitting between the ribs of a patient and having a width in a second dimension which is larger to effect an area of said contacting surface which is substantially larger than the cross-sectional area of said handpiece;
an aperture in said contacting surface communicating with said second passage for transmitting the laser beam; and focusing means in said barrel for focusing the laser beam proximate to the aperture to ablate the tissue of the heart wall and create a hole to the interior heart chamber.
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US541,793 | 1995-10-10 | ||
US08/541,793 US5700259A (en) | 1990-09-24 | 1995-10-10 | Thoracoscopic transmyocardial revascularization handpiece assembly |
Publications (1)
Publication Number | Publication Date |
---|---|
CA2207242A1 true CA2207242A1 (en) | 1997-04-17 |
Family
ID=24161073
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
CA002207242A Abandoned CA2207242A1 (en) | 1995-10-10 | 1996-09-23 | Thoracoscopic transmyocardial revascularization handpiece assembly |
Country Status (6)
Country | Link |
---|---|
US (1) | US5700259A (en) |
EP (1) | EP0798988A4 (en) |
JP (1) | JPH10510464A (en) |
AU (1) | AU7077496A (en) |
CA (1) | CA2207242A1 (en) |
WO (1) | WO1997013468A1 (en) |
Families Citing this family (31)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5728091A (en) * | 1995-06-07 | 1998-03-17 | Cardiogenesis Corporation | Optical fiber for myocardial channel formation |
US5725523A (en) * | 1996-03-29 | 1998-03-10 | Mueller; Richard L. | Lateral-and posterior-aspect method and apparatus for laser-assisted transmyocardial revascularization and other surgical applications |
US6283955B1 (en) | 1996-05-13 | 2001-09-04 | Edwards Lifesciences Corp. | Laser ablation device |
US5980545A (en) * | 1996-05-13 | 1999-11-09 | United States Surgical Corporation | Coring device and method |
US5807383A (en) * | 1996-05-13 | 1998-09-15 | United States Surgical Corporation | Lasing device |
US5662124A (en) | 1996-06-19 | 1997-09-02 | Wilk Patent Development Corp. | Coronary artery by-pass method |
US5944716A (en) * | 1996-12-09 | 1999-08-31 | Scimed Life Systems, Inc. | Radio frequency transmyocardial revascularization corer |
US6030380A (en) * | 1996-12-09 | 2000-02-29 | Bsc Northwest Technology Center, Inc. | Radio frequency transmyocardial revascularization |
US5897550A (en) * | 1996-12-11 | 1999-04-27 | Plc Medical Systems, Inc. | Sensor system for detecting concealed blood vessels |
US5947989A (en) * | 1996-12-12 | 1999-09-07 | United States Surgical Corporation | Method and apparatus for transmyocardial revascularization |
US5968059A (en) | 1997-03-06 | 1999-10-19 | Scimed Life Systems, Inc. | Transmyocardial revascularization catheter and method |
US5938632A (en) * | 1997-03-06 | 1999-08-17 | Scimed Life Systems, Inc. | Radiofrequency transmyocardial revascularization apparatus and method |
US6045565A (en) * | 1997-11-04 | 2000-04-04 | Scimed Life Systems, Inc. | Percutaneous myocardial revascularization growth factor mediums and method |
US5911729A (en) * | 1997-08-13 | 1999-06-15 | United States Surgical Corporation | Electrocautery coring using solid needle |
US6416490B1 (en) | 1997-11-04 | 2002-07-09 | Scimed Life Systems, Inc. | PMR device and method |
US6056743A (en) * | 1997-11-04 | 2000-05-02 | Scimed Life Systems, Inc. | Percutaneous myocardial revascularization device and method |
US6749617B1 (en) | 1997-11-04 | 2004-06-15 | Scimed Life Systems, Inc. | Catheter and implants for the delivery of therapeutic agents to tissues |
US6063082A (en) * | 1997-11-04 | 2000-05-16 | Scimed Life Systems, Inc. | Percutaneous myocardial revascularization basket delivery system and radiofrequency therapeutic device |
US6200311B1 (en) | 1998-01-20 | 2001-03-13 | Eclipse Surgical Technologies, Inc. | Minimally invasive TMR device |
AU1848599A (en) | 1998-02-27 | 1999-09-09 | Eclipse Surgical Technologies, Inc. | Viewing surgical scope for minimally invasive procedures |
US6093185A (en) * | 1998-03-05 | 2000-07-25 | Scimed Life Systems, Inc. | Expandable PMR device and method |
EP1089785A1 (en) | 1998-06-22 | 2001-04-11 | Neovasys, Inc. | Method, implant and delivery system for enhancing blood flow in tissue |
US6669691B1 (en) | 2000-07-18 | 2003-12-30 | Scimed Life Systems, Inc. | Epicardial myocardial revascularization and denervation methods and apparatus |
US6613017B1 (en) * | 2000-08-08 | 2003-09-02 | Scimed Life Systems, Inc. | Controlled depth injection device and method |
US6595958B1 (en) | 2000-08-08 | 2003-07-22 | Scimed Life Systems, Inc. | Tortuous path injection device and method |
US6893421B1 (en) | 2000-08-08 | 2005-05-17 | Scimed Life Systems, Inc. | Catheter shaft assembly |
US6582400B1 (en) * | 2000-10-24 | 2003-06-24 | Scimed Life Systems, Inc. | Variable tip catheter |
US6530914B1 (en) | 2000-10-24 | 2003-03-11 | Scimed Life Systems, Inc. | Deflectable tip guide in guide system |
US6616626B2 (en) | 2000-12-21 | 2003-09-09 | Scimed Life Systems, Inc. | Infusion devices and method |
US20020107510A1 (en) * | 2001-02-05 | 2002-08-08 | Andrews Robert R. | Laser apparatus useful for myocardial revascularization |
CA2958963C (en) * | 2008-10-15 | 2020-03-24 | Biolase, Inc. | Satellite-platformed electromagnetic energy treatment device |
Family Cites Families (8)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US1135465A (en) * | 1914-07-01 | 1915-04-13 | William M Pollock | Lancet. |
IL40602A (en) * | 1972-10-17 | 1975-07-28 | Panengeneering Ltd | Laser device particularly useful as surgical scalpel |
IL40603A (en) * | 1972-10-17 | 1975-12-31 | Laser Ind Ltd | Laser device with articulated arm |
US4469098A (en) * | 1978-12-18 | 1984-09-04 | Davi Samantha K | Apparatus for and method of utilizing energy to excise pathological tissue |
US4917083A (en) * | 1988-03-04 | 1990-04-17 | Heraeus Lasersonics, Inc. | Delivery arrangement for a laser medical system |
US5085663A (en) * | 1989-12-27 | 1992-02-04 | Bernard Tarr | Surgical knife with angular cut control and method of using the same |
US5125926A (en) * | 1990-09-24 | 1992-06-30 | Laser Engineering, Inc. | Heart-synchronized pulsed laser system |
US5200604A (en) * | 1991-08-07 | 1993-04-06 | Laser Engineering, Inc. | Handpiece optical proximity detector for disabling surgical laser beam |
-
1995
- 1995-10-10 US US08/541,793 patent/US5700259A/en not_active Expired - Fee Related
-
1996
- 1996-09-23 EP EP96931662A patent/EP0798988A4/en not_active Withdrawn
- 1996-09-23 JP JP9515045A patent/JPH10510464A/en active Pending
- 1996-09-23 CA CA002207242A patent/CA2207242A1/en not_active Abandoned
- 1996-09-23 WO PCT/US1996/015116 patent/WO1997013468A1/en not_active Application Discontinuation
- 1996-09-23 AU AU70774/96A patent/AU7077496A/en not_active Abandoned
Also Published As
Publication number | Publication date |
---|---|
EP0798988A1 (en) | 1997-10-08 |
EP0798988A4 (en) | 2000-08-02 |
JPH10510464A (en) | 1998-10-13 |
WO1997013468A1 (en) | 1997-04-17 |
US5700259A (en) | 1997-12-23 |
AU7077496A (en) | 1997-04-30 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
CA2207242A1 (en) | Thoracoscopic transmyocardial revascularization handpiece assembly | |
US5685857A (en) | Thoracoscopic cannula system | |
JP3299792B2 (en) | Electrosurgical equipment | |
CA2535467C (en) | Electrosurgical device | |
US7611511B2 (en) | Bipolar medical instrument and electrosurgical system comprising such an instrument | |
US5674184A (en) | Surgical trocars with cutting electrode and viewing rod | |
US5122138A (en) | Tissue vaporizing accessory and method for an endoscope | |
JP3423733B2 (en) | Endoscopic surgical instruments for suction and irrigation | |
US5832929A (en) | Video assisted thoracoscopic transmyocardial revascularization surgical method | |
US7955328B2 (en) | Tissue dissector and/or coagulator with a slit in an insulating tip to control the direction of energy | |
US20100094283A1 (en) | Multifunctional telescopic monopolar/bipolar surgical device and method therefore | |
GB2311468A (en) | Electrosurgical interstitial resector | |
US20080103431A1 (en) | Suction sleeve and interventional devices having such a suction sleeve | |
US5681276A (en) | Medical probe device and electrode assembly for use therewith | |
WO2003096871A2 (en) | Multipurpose fluid jet surgical device | |
WO1994014383A1 (en) | Handpiece for transmyocardial vascularization heart-synchronized pulsed laser system | |
US7160295B1 (en) | Flexible electrosurgical electrode for treating tissue | |
US6231578B1 (en) | Ultrasonic snare for excising tissue | |
US20020183589A1 (en) | Urological resectoscope comprising a contacting device | |
US6113587A (en) | Handpiece for a medical laser system | |
US11857242B2 (en) | Attachment for electrosurgical system | |
US20210378729A1 (en) | Electrode unit and endoscope system | |
US6132422A (en) | Handpiece for transmyocardial vascularization heart-synchronized pulsed laser system | |
EP0626826B1 (en) | Handpiece for transmyocardial vascularization heart-synchronized pulsed laser system | |
GB2612944A (en) | Electrode assembly |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
EEER | Examination request | ||
FZDE | Dead |